Why the WHO community outreach label doesn't mean much

Believe it or not, countries like Italy and Spain with more than 1.5 lakh of Covid-19 cases and thousands of deaths each are not classified as being in the community transmission stage in the WHO daily situation reports. And yet Syria with only 25 cases and two deaths is at this stage.

How is this possible? As of April 9, the WHO reports which countries they define as their transmission stage. Even Italy, Spain, France and the United Kingdom are not among the 22 countries in the community transmission category. All of them, and most of the European countries, appear as pending classification.

Before that date, the transmission classification was based on the WHO analysis of official data on reported cases and deaths by country. The daily status report presents a list of countries with data on the total number of confirmed cases, new cases, total deaths and new deaths, and the country's transmission classification. Countries send detailed case and death data in a standard format to WHO on a daily basis.

The broadcast scenarios also changed from April 9. These changes were based on an updated guide for member states on the implementation of global surveillance for Covid-19 issued on March 20. Prior to April 9, transmission scenarios were 1) under investigation, 2) imported only cases, 3) local transmission 4) community transmission, and 5) interrupted transmission, although details of how transmission interruption would have been demonstrated were not they had been resolved.

The new transmission scenarios are 1) without cases 2) sporadic cases 3) groups of cases and 4) community transmission. Sporadic cases seem to combine the two previous classifications of imported cases and local transmission, since it has been defined as countries or areas with one or more cases, imported or detected locally. However, case groups, defined as countries “experiencing cases, grouped by time, geographic location and/or by common exposures” is an additional scenario that has been introduced. The definition of community transmission has remained more or less the same.

In the new self-report format, such as April 12, most of the 215 countries or territories that reported data to WHO, 81 classified their transmission scenario as case groups. These included China with more than 83,000 cases and more than 3,300 deaths, as well as India with more than 8,000 cases and 273 deaths and even Maldives and Granada with 19 and 14 cases respectively and zero deaths.

Most of the 22 countries in the community transmission scenario are in the Americas, including the United States, Canada, Brazil, and Mexico. But it also includes South Africa with 2,028 cases and 25 deaths and Syria with only two deaths.

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Almost all 60 countries classified as sporadic cases have few or no deaths and almost none have reported new deaths. New Zealand has the highest number of cases in this group, 1,079 cases, with 1 new case and a total of four deaths. Most of Africa falls into this category. Up to 49 countries, most in Europe, are listed as pending along with the UAE and Qatar, two critical points of infection among the Gulf countries.

In response to TOI's questions about the changes, a WHO spokesperson explained:

“According to the WHO definition, community transmission occurs when countries experience a large number of cases that are not linked to transmission chains with multiple groups in different areas and face challenges in tracking all chains of spread. Although many countries face this situation now, each country deals with a unique epidemiology and context, with patterns that may differ between areas of the same country. For this reason, WHO believes that countries should ultimately decide their own transmission classification and we continue to support all countries with their self-report process.